Publication: Rwanda : Fiscal Space for Health and the MDGs Revisited
Loading...
Date
2009-11
ISSN
Published
2009-11
Author(s)
Editor(s)
Abstract
This paper revisits the issue of fiscal space requirements for achieving health millennium development goals (MDGs) in Rwanda. The paper updates and extends work on financing for the health MDGs prepared by the Ministry of Health (MoH) in 2006. It draws on papers prepared by World Bank staff for a comprehensive health sector review and information collected during a field visit to Kigali in March 2008. The context is one of large recent increases of financing from development partners (donors) combined with far reaching reforms of health sector management. The paper aims to provide a concise summary of the key issues for policymakers in Rwanda, development partners, and to inform a broader international audience of the prospects for scaling up financing for health in order to substantially raise the health status of low income country populations. The plan of the paper is as follows: section one describes the demographic and health context, the strategic objectives through to 2015, and recent and prospective progress towards achieving these objectives; section two briefly explains the distinctive features of health financing with an emphasis on primary and secondary services needed to achieve strategic objectives; section three considers financial flows in the health sector; section four elaborates a forward-looking fiscal space for health scenario; section five compares projections of fiscal space and alignment of health spending with a costing scenario developed using the marginal budgeting for bottlenecks (MBB) tool; section six concludes with a discussion of the uses and potential of government-development partner compact for health sector financing in support of a long term health strategy.
Link to Data Set
Citation
“Lane, Chris. 2009. Rwanda : Fiscal Space for Health and the MDGs Revisited. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank. http://hdl.handle.net/10986/13637 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Related items
Showing items related by metadata.
Publication Equity, Access to Health Care Services and Expenditures on Health in Nicaragua(World Bank, Washington, DC, 2008-06)Nicaragua has embarked on an ambitious health sector program, which has contributed to significant progress in the health sector over the past decade. Health indicators show gradual but steady improvements: access to basic services such as clean water and sanitation facilities has improved, as have other related performance indicators such as life expectancy, infant/child mortality, immunization rates, and child nutrition among others. Despite these achievements, there are still large inequities in access and quality of health services across socioeconomic groups and regions. Poor individuals living in rural areas (especially in the Central and Atlantic regions), the indigenous population, and individuals living in households engaged in agriculture have average access to health care services and preventive care. The lack of risk mitigation mechanisms such as insurance and social security is causing users in Nicaragua to spend, out-of-pocket, a significant share of their income on health care, especially to buy medications and other non-consultation items such as medical tests. Long distances, lack of medicines, and high costs and other demand-side factors (such as self-prescription) constitute the main constraints causing poor and sick individuals to seek informal care or not to seek care at all.Publication Capacity Assessment of the Ministry of Health of the Republic of Angola(World Bank, Washington, DC, 2006-06)The World Bank commissioned a capacity assessment study of the Ministry of Health (MOH) that was undertaken in March 2006. The terms of reference covered the following areas: Identify the existing analytical work being done by other donors in the health field and summarize their terms of reference and main conclusions; assess the MOH capacity to implement health policies and strategies adopted by the government; assess the MOH capacity to implement projects financed by the Bank, the Global fund, EU and others focusing the analysis on the MOH capacity for policy formulation, mobilization of funds, and program implementation; assess the capacity at central, provincial and municipal level in (i) program management, (ii) service delivery, including the number and distribution of staff; analyze the decision making process and the incentives for decision making including how much the system is centralized or decentralized; analyze the existing stock of health professionals including the MOH and military, identifying key constraints and gaps in capacity, government plans to increase capacity; existing training institutions and their capacity to produce new professionals and follow-up training; propose options for short term and long-term interventions including training managers, training of doctors and nurses, recruitment, on-job-training, review of curricula and other; make cost estimates of short term capacity building interventions that could be financed by the Bank and other donors; and identify future work that may be needed to undertake deeper or follow-up analysis.Publication Health, Nutrition, and Population in Madagascar 2000-09(World Bank, 2011-07-05)With an income per capita US$400 in 2008, Madagascar is one of the poorest countries in the world. Poverty is widespread but with significant urban-rural differences (52 percent versus 74 percent). Health, nutrition, and the fight against communicable diseases and HIV/AIDS are key goals of the country's poverty reduction strategy, the Madagascar Action Plan 2007-2012. The National Health Sector and Social Protection Development Plan 2007-2011 was developed to strengthen the health system and improve service delivery to reduce neonatal, child and maternal mortality, address malnutrition and control communicable illnesses. The health sector has benefited from increasing investment over the last years, and a number of studies and surveys have been carried out, providing a wealth of information that is yet to be analyzed in a complementary way. This Country Status Report (CSR) seeks to capitalize on all of the existing data in the health sector, compare Madagascar to countries of similar income levels and assess the results achieved by the health system. The CSR provides an analysis of the population's health and nutrition status by linking health outcomes, household/individual behaviors, community factors, government interventions, and service provision. Although Madagascar is performing beer than the SSA average of 645 per 100,000 live births, the maternal mortality rate has stagnated over the last decade and in 2008/09 was estimated at 498. Health care seeking behavior for preventive child health services at the health facility level is improving. Complete immunization coverage stands at 62 percent in 2008 (for children 12 to 23 months), but there are still large differences in coverage across regions, place of residence, and income groups.Publication Republic of Yemen : Health Sector Strategy Note(Washington, DC, 2001-02)This report is intended to provide a base for discussions of Yemen's health sector strategy with the Government of Yemen (GOY) and other donors in light of the Ministry of Public Health (MOPH) initiative of Health Sector Reform (HSR) as well as the potential areas of World Bank support. The report is divided in nine sections. Section A provides the introduction to the report and the country context. Sections B and C review the key health indicators and trends and the key aspects of the sector in terms of financing, service delivery, human resources, health services, organizational framework, and policy environment. Sections D and E provide international comparisons and an assessment of the sector performance with regard to health outcomes, equity, access, efficiency, quality, and sustainability. Section F is an outline of the MOPH/HSR program. Sections G and H provide an overview of the Bank's current assistance and its response to HSR as well as the different donors' support. Finally, Section I outlines the future areas where the Bank can support the government in its health reform efforts. Yemen faces major challenges to improving the health status of its population, which go beyond the health delivery network. Poverty, low participation in education especially among girls, and high illiteracy are major contributing factors to poor health as are limited access to potable water and proper sanitation.Publication Peru’s Comprehensive Health Insurance and New Challenges for Universal Coverage(World Bank, Washington DC, 2013-01)This case study analyzes the progress of Peru's Comprehensive Health Insurance (SIS) and evaluates the challenges that remain to achieving universal health care coverage. Peru is an upper-middle-income country with a gross domestic product (GDP) per capita of just over US$10,000 (purchasing power parity). The country has grown rapidly in the last decade; the average growth rate was 6.5 percent. However, 28 percent of the population lives in poverty (2011), which is estimated with regionally differentiated poverty lines between US$1 and US$2 per capita per day. In addition, only one in four individuals has employment with social security coverage. The SIS aims to reduce economic barriers through the elimination of user fees for a package of services. Although its budget has been low, the SIS has played an important role in the reduction of maternal and child mortality. However, the improvements expected to the overall health system have not materialized. Meanwhile, when the decentralization process transferred funds and authority to the regions, it did so in a context of weak management capabilities, and it failed to clearly define the relationship between the national and regional governments. A major effort to strengthen the technical capacity of the Ministry of Health (MOH) should accompany the strategies outlined above. This effort should emphasize a review of health priorities, the design of effective interventions within a fiscally sustainable benefits package, and the introduction of incentives and new payment mechanisms at hospitals and other health facilities.
Users also downloaded
Showing related downloaded files
Error: Could not load results for 'https://openknowledge.worldbank.org/server/api/item/relateditemlistconfigs/f0fa975b-7a2b-5dd7-8d53-a52cef0cf026_downloads/itemlist'.